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Li M, Zhao L, Zhang L, Li P, Zhang X, Wang C, Li X, Wu S, Sun L. Factors influencing normal blood pressure maintenance in young adults. J Clin Hypertens (Greenwich) 2023; 25:725-736. [PMID: 37461269 PMCID: PMC10423756 DOI: 10.1111/jch.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
Despite an alarming increase in the prevalence of hypertension among Chinese young adults, longitudinal studies investigating factors that affect the maintenance of normal blood pressure (BP) in this population are lacking. Our study aimed to address this knowledge gap. A total of 7100 participants from the Kailuan Study who had normal BP and were aged <30 years at their first physical examination between 2006 and 2016 were included in this study. Cox proportional hazards regression models were used to assess hazard ratios (HR), and 95% confidence intervals (CI) were calculated to assess the associations between influencing factors and the maintenance of normal BP in young adults. Analyses were stratified by sex. During the follow-up period (mean, 7.98 years), 1921 participants (27.06%) maintained normal BP. Higher education levels (HR, 1.11; 95% CI, 1.00-1.22), low salt intake (HR, 1.25; 95% CI, 1.04-1.51), being underweight (HR, 1.16; 95% CI, 1.02-1.31), and having normal weight (HR, 1.19; 95% CI, 1.01-1.39), normal blood glucose (HR, 1.22; 95% CI, 1.02-1.46), and no family history of hypertension (HR, 1.65; 95% CI, 1.41-1.92) at baseline were found to be associated with maintaining normal BP. Compared with female smokers, female non-smokers had 1.68 times higher odds of maintaining normal BP. This study identified factors that influence the maintenance of normal BP in the young population in China. This information can assist clinicians in establishing comprehensive and effective primary prevention measures for hypertension.
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Affiliation(s)
- Man Li
- Department of EmergencyThe Affiliated Hospital of North China University of Science and TechnologyTangshanChina
- School of clinical medicineNorth China University of Science and TechnologyTangshanHebeiChina
| | - Lei Zhao
- Department of EmergencyThe Affiliated Hospital of North China University of Science and TechnologyTangshanChina
| | - Li Zhang
- Department of EmergencyThe Affiliated Hospital of North China University of Science and TechnologyTangshanChina
| | - Peng Li
- Department of EmergencyThe Affiliated Hospital of North China University of Science and TechnologyTangshanChina
| | - Xiaoling Zhang
- Department of EmergencyThe Affiliated Hospital of North China University of Science and TechnologyTangshanChina
| | - Chong Wang
- Department of EmergencyThe Affiliated Hospital of North China University of Science and TechnologyTangshanChina
| | - Xinyuan Li
- Department of EmergencyThe Affiliated Hospital of North China University of Science and TechnologyTangshanChina
| | - Shouling Wu
- Department of CardiologyKailuan HospitalTangshanChina
| | - Lixia Sun
- Department of EmergencyThe Affiliated Hospital of North China University of Science and TechnologyTangshanChina
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Chen R, Ji L, Ma L, Chen Y, Duan J, Ma M, Sun Y, Tai J, Meng L. Accuracy and capability of tri-ponderal mass index in assessing cardio-metabolic risk factors in Chinese children and adolescents aged 3 to 17 years, compared with body mass index. Chin Med J (Engl) 2023; 136:1339-1348. [PMID: 36848203 PMCID: PMC10309518 DOI: 10.1097/cm9.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Tri-ponderal mass index (TMI) has been reported to be a more accurate estimate of body fat than body mass index (BMI). This study aims to compare the effectiveness of TMI and BMI in identifying hypertension, dyslipidemia, impaired fasting glucose (IFG), abdominal obesity, and clustered cardio-metabolic risk factors (CMRFs) in 3- to 17-year-old children. METHODS A total of 1587 children aged 3 to 17 years were included. Logistic regression was used to evaluate correlations between BMI and TMI. Area under the curves (AUCs) were used to compare discriminative capability among indicators. BMI was converted to BMI- z scores, and accuracy was compared by false-positive rate, false-negative rate, and total misclassification rate. RESULTS Among children aged 3 to 17 years, the mean TMI was 13.57 ± 2.50 kg/m 3 for boys and 13.3 ± 2.33 kg/m 3 for girls. Odds ratios (ORs) of TMI for hypertension, dyslipidemia, abdominal obesity, and clustered CMRFs ranged from 1.13 to 3.15, higher than BMI, whose ORs ranged from 1.08 to 2.98. AUCs showed similar ability of TMI (AUC: 0.83) and BMI (AUC: 0.85) in identifying clustered CMRFs. For abdominal obesity and hypertension, the AUC of TMI was 0.92 and 0.64, respectively, which was significantly better than that of BMI, 0.85 and 0.61. AUCs of TMI for dyslipidemia and IFG were 0.58 and 0.49. When 85th and 95th of TMI were set as thresholds, total misclassification rates of TMI for clustered CMRFs ranged from 6.5% to 16.4%, which was not significantly different from that of BMI- z scores standardized according to World Health Organization criteria. CONCLUSIONS TMI was found to have equal or even better effectiveness in comparison with BMI in identifying hypertension, abdominal obesity, and clustered CMRFs TMI was more stable than BMI in 3- to 17-year-old children, while it failed to identify dyslipidemia and IFG. It is worth considering the use of TMI for screening CMRFs in children and adolescents.
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Affiliation(s)
- Rui Chen
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing 100020, China
| | - Lang Ji
- Central Laboratory, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
| | - Lijuan Ma
- Department of Clinical Laboratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China
| | - Yitong Chen
- Infectious Diseases Control and Prevention Division, Daxing Center for Disease Prevention and Control, Beijing 102699, China
| | - Jiali Duan
- Health Promotion Office, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Mingjing Ma
- Department of Health Care, Tuanjiehu Community Health Service Center, Chaoyang District, Beijing 100026, China
| | - Ying Sun
- Health Promotion Office, Beijing Center for Disease Prevention and Control, Beijing 100013, China
| | - Jun Tai
- Department of Otorhinolaryngology, Head and Neck Surgery, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China
| | - Linghui Meng
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing 100020, China
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China
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Eslami M, Pourghazi F, Khazdouz M, Tian J, Pourrostami K, Esmaeili-Abdar Z, Ejtahed HS, Qorbani M. Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies. Front Nutr 2023; 9:985319. [PMID: 36687719 PMCID: PMC9846615 DOI: 10.3389/fnut.2022.985319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Waist circumference-to-height ratio (WHtR) is a simple anthropometric index with good screening power and fast interpretation for early detection of childhood abdominal obesity. This systematic review and meta-analysis aims to determine the best cut-off value of WHtR to use in clinical setting. Methods Comprehensive searches were conducted in PubMed, Scopus, and Web of Science by the end of March 2021. Observational studies investigated the best WHtR cut-off to detect abdominal obesity in children and adolescents were included. Thirteen articles (n = 180,119) were included in this systematic review and eight documents were included in the meta-analysis. Results The overall optimal cut-off was 0.49 with pooled sensitivity, specificity and diagnostic odds ratio (DOR) of 0.93 (95% confidence interval (CI): 0.93-0.96), 0.88 (95% CI: 0.85-0.91) and 102.6 (95% CI: 50.7-207.5), respectively. The optimal WHtR cut-off to predict abdominal obesity in girls and boys were both 0.49. Discussion The current study shows that we could use this cut-off as a simple index for predicting abdominal obesity in children and adolescents without the need for any charts in practice.
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Affiliation(s)
- Maysa Eslami
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Pourghazi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khazdouz
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Kumars Pourrostami
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Zahra Esmaeili-Abdar
- Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Liang X, Tang X, Xi B, Qu P, Ren Y, Hao G. Abdominal obesity-related lipid metabolites may mediate the association between obesity and glucose dysregulation. Pediatr Res 2023; 93:183-188. [PMID: 35437306 DOI: 10.1038/s41390-022-02074-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/22/2022] [Accepted: 03/29/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Children with obesity is associated with a higher risk of cardiovascular disease (CV) risk in adulthood. This study is to explore the obesity-related lipid metabolites and identify the associations of lipid metabolites with selected CV risk in children and adolescents. METHODS A case-control study was designed to include a total of 197 children (aged 9-13 years, male 56.34%, 99 children in the obesity group). The lipidomics profiling was measured by ultra-high-performance liquid tandem chromatography quadrupole time-of-flight mass spectrometry. RESULTS Four FDR-significant abdominal obesity-related lipid metabolites were identified. Compared to the lean group, decreased phosphatidylcholine O-21:2 level (q = 0.010) and sphingomyelins d21:1 (q = 0.029) were found and two lipid metabolites levels were higher in the obese group, including phosphatidylglycerol 43:6 and one did not match with any candidate compounds in databases. After adjusting for covariates, PC3 (O-21:2) and SM (d21:1) were significantly associated with blood glucose. Mediation analysis showed that all three lipid metabolites may mediate the association between abdominal obesity and glucose regulation. CONCLUSIONS This study identified several novel central obesity-related lipid metabolites, and we found that PC3 (O-21:2) and SM (d21:1) were significantly associated with blood glucose, and all these lipid metabolites can mediate the association between abdominal obesity and glucose dysregulation. IMPACT Serum lipidomic profiles in children with abdominal obesity and their associations with selected CV risk factors were examined. Our study identified 4 lipid metabolites associated with abdominal obesity, including PC3 (O-21:2), SM (d21:1), PG (43:6), and one did not match with any candidate compounds in the databases. PC3 (O-21:2) and SM (d21:1) were significantly associated with blood glucose. Mediation analysis showed that all three lipid metabolites [PC3 (O-21:2), SM (d21:1), PG (43:6)] may mediate the association between abdominal obesity and abnormal glucose regulation. This study identified several novel obesity-related lipid metabolites.
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Affiliation(s)
- Xiaohua Liang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
| | - Xian Tang
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Ping Qu
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yanling Ren
- Department of Clinical Epidemiology and Biostatistics, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Guang Hao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong Province, China.
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Tuglo LS. Comparison of adiposity anthropometric indices and their associations with visceral fat levels determined by bioelectrical impedance analysis among diabetic patients. Sci Rep 2022; 12:17824. [PMID: 36280694 PMCID: PMC9592612 DOI: 10.1038/s41598-022-22848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/20/2022] [Indexed: 01/20/2023] Open
Abstract
Visceral fat (VF) and its effect on metabolic disorders have been extensively studied; nevertheless, there is a need for a simple and reliable index to equally assess VF in low-resource settings. This multihospital-based study was designed to compare the five adiposity anthropometric indices and their associations with VF levels determined by bioelectrical impedance analysis as the reference standard among diabetic patients. A pretested questionnaire was used to collect anthropometric, biochemical and hemodynamic data from 473 diabetic patients. Regression analysis was performed to determine the associations between the five adiposity anthropometric indices and VF levels. Receiver operating characteristic (ROC) curves were used to confirm the predictive capacities of the five adiposity anthropometric indices with VF levels. The waist-to-height ratio WHtR showed the greatest ROC value [area under the curve (AUC) = 0.745, p ˂0.001] in identifying diabetic patients with high VF levels compared to body mass index BMI [AUC = 0.584, p = 0.047], waist circumference WC [AUC = 0.723, p ˂0.001], hip circumference HC [AUC = 0.647, p ˂0.001] and waist-to-hip ratio WHR [AUC = 0.711, p ˂0.001]. Likewise, the regression analysis of WHtR and VF levels revealed the strongest association [unadjusted odds ratio (UOR) = 21.49, p < 0.001] compared to BMI [UOR = 6.77, p = 0.008], WC [UOR = 6.37, p < 0.001], HC [UOR = 5.93, p = 0.002] and WHR [UOR = 13.17, p < 0.001]. The optimal cut-off values to identify diabetic patients with high VF levels were > 0.5 for WHtR, > 25.7 kg/m2 for BMI, > 80.5 cm for WC, > 95.5 cm for HC and > 0.82 for WHR. WHtR was shown to have overpowered BMI, HC, WC and WHR in identifying diabetic patients with high VF levels. Therefore, the Ghana Health Service could recommend WHtR as a better diagnostic index for assessing VF levels due to its high predictive capacity.
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Affiliation(s)
- Lawrence Sena Tuglo
- grid.449729.50000 0004 7707 5975Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
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Zhang F, Han Y, Wang H, Li Y, Yan Z. Diagnostic test accuracy of waist-to-height ratio as a screening tool for cardiovascular risk in children and adolescents: a meta-analysis. Ann Hum Biol 2022; 49:217-227. [PMID: 36121693 DOI: 10.1080/03014460.2022.2126523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
CONTEXT Waist-to-height ratio (WHtR) is a controversial evaluation index of cardiovascular risk factors (CVRFs) in children and adolescents. OBJECTIVE To assess the accuracy of WHtR as a measure to screen for clusters of at least one CVRF (CVRF1), two CVRFs (CVRF2), and three CVRFs (CVRF3) in different ages, sexes, regions and cut-offs. METHODS The PubMed, Web of Science, EBSCOhost, Springer, Taylor & Francis Online, Wiley Online Library, Wanfang, and CNKI databases were searched for eligible publications up to June 2021. The QUADAS-2 checklist was used to assess the methodology of the included studies. RESULTS Twenty-two studies that evaluated 85281 children and adolescents aged 5-19 years were included in the meta-analysis. The AUSROC values were 0.56 (95% CI: 0.54-0.57), 0.82 (95% CI: 0.81-0.83), and 0.89 (95% CI: 0.89-0.90) for CVRF1, CVRF2, and CVRF3, respectively. Higher AUSROC values were found for adolescents (12-19 years), that is, 0.91 (95% CI: 0.88-0.93), 0.90 (95% CI: 0.87-0.92) for males, and 0.91 (95% CI: 0.90-0.91) for a cut-off of ≥ 0.51 in the identification of CVRF3. CONCLUSION WHtR can be used as an accurate screening tool for CVRF3 and CVRF2 in children and adolescents, and it is recommended to select different cut-offs according to different ages, sexes, and regions.
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Affiliation(s)
- Fusheng Zhang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China.,School of Physical Education, Zhaotong University, Zhaotong, China
| | - Yanbai Han
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Hongli Wang
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Yong Li
- College of Physical Education and Health, Guangxi Normal University, Guilin, China
| | - Zhiwei Yan
- Department of Sports Rehabilitation, College of Human Kinesiology, Shenyang Sport University, Shenyang, China
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Dang J, Ma N, Liu Y, Zhong P, Shi D, Cai S, Dong Y, Zou Z, Ma Y, Song Y, Ma J. The independent and combined effects of single-child status and ideal lifestyle on clustered cardio-metabolic risk factors among Chinese children and adolescents. Front Nutr 2022; 9:987334. [PMID: 36105575 PMCID: PMC9464906 DOI: 10.3389/fnut.2022.987334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCardio-metabolic risk factors (CMRFs) represent the accumulation of metabolic abnormalities, significantly increasing the likelihood of cardiovascular diseases. Although studies assessed the independent association of single-child status and lifestyle risk factors with components of CMRFs or clustered CMRFs, little has been known about the combined effect of single-child status and lifestyles on clustered CMRFs as well as sex differences.Materials and methodsData was collected from a cross-sectional survey conducted in September 2013 in China. A total of 13,859 children and adolescents aged 7–18 years with blood samples were included. Anthropometric measurements and serum biochemical indexes were collected to assess clustered CMRFs, while questionnaires were used to obtain single-child status, lifestyle information, and characteristics of children and their parents. Mixed effect logistic regression was applied to analyze the independent and the combined effects of single-child status and ideal lifestyle category on clustered CMRFs.ResultsThe prevalence of clustered CMRFs was 3.4%, with a higher prevalence in boys (4.0%) than girls (2.7%). Children and adolescents with clustered CMRFs had a higher proportion of single children (76.6 vs. 69.7%) and unfavorable lifestyles (62.1 vs. 29.2%) compared with their peers with non-clustered CMRFs. Both single children (OR = 1.67, 95% CI: 1.32–2.11) and unfavorable lifestyles (OR = 9.03, 95% CI: 6.26–13.02) were associated with an increased risk of clustered CMRFs. The risk of clustered CMRFs increased significantly (OR = 12.79, 95% CI: 6.67–24.52) when single children and an unfavorable lifestyle were combined, which was almost neutralized (OR = 1.33, 95% CI: 0.63–2.82) when single children adhered to a favorable lifestyle. However, no sex differences were observed in this study.ConclusionSingle children with unfavorable lifestyles were associated with an obvious risk of clustered CMRFs, which might be partially offset by expanding family size (the number of siblings) or establishing a favorable lifestyle. A birth-friendly social environment as well as a family environment with a favorable lifestyle are encouraged in China.
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Affiliation(s)
- Jiajia Dang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Ning Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yunfei Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Panliang Zhong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Di Shi
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Shan Cai
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- *Correspondence: Yi Song,
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China
- Jun Ma,
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The Combined Effect of Birth Weight and Lifestyle on Clustered Cardio-Metabolic Risk Factors in Children and Adolescents: A National School-Based Cross-Sectional Survey. Nutrients 2022; 14:nu14153131. [PMID: 35956308 PMCID: PMC9370142 DOI: 10.3390/nu14153131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Due to the adverse effects of cardio-metabolic risk factors (CMRFs) in children and adolescents on their current and later life health, and the growing evidence that birth weight and lifestyle have on CMRFs, we aimed to estimate the combined effect of birth weight and lifestyle on clustered CMRFs in children and adolescents. Methods: We enrolled 11,509 participants aged 7–18 years old in a national school-based cross-sectional study in seven provinces in China in 2013. Information on CMRFs was collected through anthropometric measurements and blood sample testing. Information on birth weight, lifestyle and other basic information were investigated through children and adolescents’ as well as parents’ questionnaires. The generalized linear mixed model was applied to estimate the odd ratio (OR) and 95% confidence interval (95% CI) for the associations between CMRFs, clustered CMRFs and birth weight, lifestyle, and the combinations of birth weight and lifestyle. Results: Overall, the prevalence of clustered CMRFs was 3.6% in children and adolescents aged 7–18 years, higher in boys (4.4%) than girls (2.9%). The combination of LBW/ideal lifestyle (OR = 2.00, 95% CI: 1.07–3.72) was associated with higher risk of clustered CMRFs, as well as in adolescents aged 13–18 years and in boys. The combination of HBW/poor lifestyle (OR = 1.74, 95% CI: 1.13–2.68) was related to elevated risk of clustered CMRFs, especially in children aged 7–12 years. Conclusions: CMRFs in Chinese children and adolescents is concerning, ideal lifestyle could weaken the association of birth weight with clustered CMRFs, especially in younger age, indicating that programs to prevent abnormal birth weight or poor lifestyle or both among children and adolescents may reduce CMRFs in China.
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Tong J, Li X, Liang X, Tang F, Ren Y, Hao G, Peng X, Luo S, Feng Y, Huang D, Zhao L, Liang X. The relationship of remnant cholesterol and abdominal obesity in children: A cross-sectional study. Front Cardiovasc Med 2022; 9:929560. [PMID: 35966536 PMCID: PMC9363601 DOI: 10.3389/fcvm.2022.929560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/30/2022] [Indexed: 11/15/2022] Open
Abstract
Background Previous studies found that remnant cholesterol (RC) is a risk factor for cardiovascular diseases and childhood obesity is associated with cardiometabolic diseases. This study aimed to explore the relationship between RC and abdominal obesity in children. Methods A total of 5,959 children, aged 6−12 years old, were selected from a cross-sectional study in urban-rural areas of Chongqing, China. RC was calculated by total cholesterol (TC)—high-density lipoprotein (HDL-C) cholesterol—low-density lipoprotein (LDL-C) cholesterol and was divided into four groups by quartiles (Q1–Q4). Results Compared to children with the lowest RC (Q1), children with higher RC had significantly higher odds of abdominal obesity (Q2: OR = 1.450, 95% CI: 1.131−1.859, p < 0.05; Q3: OR = 2.127, 95% CI: 1.632−2.772, p < 0.001; Q4: OR = 2.386, 95% CI: 1.819−3.130, p < 0.001). In the stratified analyses by urban-rural areas, the odds ratios were greater in rural areas (Q2: OR = 2.228, 95% CI: 1.572−3.160, p < 0.001; Q3: OR = 3.668, 95% CI: 2.191−6.140, p < 0.001; Q4: OR = 6.490, 95% CI: 2.271−18.551, p < 0.001) than in urban areas (Q2: OR = 1.644, 95% CI: 1.192−2.266, p < 0.05; Q3: OR = 2.266, 95% CI: 1.667−3.082, p < 0.001; Q4: OR = 2.711, 95% CI: 2.005−3.665, p < 0.001). Conclusions Our study found that RC was positively correlated with abdominal obesity in children, and this association was higher for children living in rural areas.
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Affiliation(s)
- Jishuang Tong
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
- Shimian People's Hospital, Ya'an, China
| | | | - Xiaoyue Liang
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Fang Tang
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
- Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Yanling Ren
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Guang Hao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xin Peng
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Sunqing Luo
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Ye Feng
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Daochao Huang
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Li Zhao
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Xiaohua Liang
- Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
- *Correspondence: Xiaohua Liang ,
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Fu L, Cheng H, Zhao X, Hou D, Xie X, Mi J. Distinct causal effects of body fat distribution on cardiometabolic traits among children: Findings from the BCAMS study. Nutr Metab Cardiovasc Dis 2022; 32:1753-1765. [PMID: 35599089 DOI: 10.1016/j.numecd.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Observational studies reveal that different body fat measures are associated with cardiometabolic disease with different effects. However, causality is not reflected by such observations. To explore and compare the causal relationships of general obesity (measured by body mass index (BMI)), adipose obesity (measured by fat mass percentage (FMP)) and central obesity (measured by waist-to-height ratio (WHtR)) with cardiometabolic traits among children. METHODS AND RESULTS We conducted one sample Mendelian randomization (MR) analysis in 3266 children from Beijing Children and Adolescents Metabolic Syndrome Study. Genetic instruments based on 28 SNPs were performed to explore and compare the causal associations of genetically BMI, FMP and WHtR with cardiometabolic traits. The genetic instruments were robustly correlated with observed BMI, FMP and WHtR. Each genetically 1-SD increment in BMI, FMP and WHtR were causally associated with increment in systolic blood pressure (SBP), diastolic blood pressure (DBP), log-transformed fasting plasma glucose (FPG), log-transformed HOMA-β, and decrease in log-transformed high-density lipoprotein cholesterol (HDL), respectively (all P < 0.05 after Bonferroni correction). The receiver operating characteristic curve indicated that BMI and FMP showed stronger effects on SBP, DBP, HOMA-β and HDL than WHtR (all P < 0.05). We also observed causal associations of BMI and FMP with log-transformed fasting insulin and HOMA-IR. CONCLUSIONS The MR analysis based on population-based cohort indicated a causal relationship of adiposity and body fat distribution with cardiometabolic traits. When compared with central obesity, general obesity and adipose obesity might own stronger effects on blood pressure and blood lipids among children.
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Affiliation(s)
- Liwan Fu
- Center for Non-communicable Disease Management, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hong Cheng
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Xiaoyuan Zhao
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Dongqing Hou
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Xianghui Xie
- Capital Institute of Pediatrics, Beijing, China.
| | - Jie Mi
- Center for Non-communicable Disease Management, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Key Laboratory of Major Diseases in Children, Ministry of Education, China.
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11
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Tong J, Ren Y, Liu F, Liang F, Tang X, Huang D, An X, Liang X. The Impact of PM2.5 on the Growth Curves of Children's Obesity Indexes: A Prospective Cohort Study. Front Public Health 2022; 10:843622. [PMID: 35392463 PMCID: PMC8980359 DOI: 10.3389/fpubh.2022.843622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/10/2022] [Indexed: 12/11/2022] Open
Abstract
Aims To explore the effect of long-term exposure to particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) on childhood obesity based on a cohort study in Chongqing. Methods A total of 4,284 children aged 6-8 years at baseline were enrolled from the Chongqing Children Health Cohort in 2014-2015 and were followed up in 2019. A stratified cluster sampling was applied to select the participants. A Mixed-effects linear regression model was used to examine the effect of long-term exposure to PM2.5 on the growth curve of obesity indicators [including body mass index (BMI), BMI Z-score (BMIz), and waist-to-height ratio (WHtR)]. A mixed-effects logistic regression model was used to study the dose relationship between PM2.5 exposure and the risk of obesity indicators. Results A higher level of accumulating exposure to PM2.5 was associated with an increased childhood obesity index, and the effect was the most significant for WHtR than BMI and BMIz. This effect was more pronounced in boys than in girls except for WHtR, and it was the most significant under the PM2.5 exposure period from pregnancy to 6 years old. Compared the annual average PM2.5 exposure level of <60 μg/m3, the WHtR and BMI were increased by 0.019 [(95% CIs): 0.014, 0.024] and 0.326 [(95% CIs): 0.037, 0.616] Kg/m2 for participants living with the PM2.5 exposure level of 70-75 μg/m3, respectively. For every 5 μg/m3 increase in PM2.5 levels (from pregnancy to 6 years old), the risk of central obesity was increased by 1.26 {odds ratio [OR] (95% CIs): 1.26 (1.16, 1.37), p < 0.001} times. Conclusions This study confirmed a dose-response relationship between PM2.5 exposure and childhood obesity, especially central obesity, suggesting that controlling ambient air pollution can prevent the occurrence of obesity in children and adolescents.
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Affiliation(s)
- Jishuang Tong
- Department of Clinical Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yanling Ren
- Department of Clinical Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengchao Liang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Xian Tang
- Department of Clinical Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Daochao Huang
- Department of Clinical Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xizhou An
- Department of Clinical Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaohua Liang
- Department of Clinical Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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12
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Chen R, Ji L, Chen Y, Meng L. Weight-to-height ratio and body roundness index are superior indicators to assess cardio-metabolic risks in Chinese children and adolescents: compared with body mass index and a body shape index. Transl Pediatr 2022; 11:318-329. [PMID: 35378962 PMCID: PMC8976678 DOI: 10.21037/tp-21-479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/18/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To assess the relationship between five anthropometric indicators, which includes body mass index (BMI), weight-to-height ratio (WHtR), a body shape index (ABSI), ABSI-adolescents, and body roundness index (BRI) in Chinese children and adolescents, and select which could better predict cardio-metabolic risk factors (CMRFs). METHODS Cross-sectional study with 1,587 participants aged 3 to 17 years. Five anthropometric indicators were calculated according to weight, height and waist circumference (WC). Anthropometric measurements and laboratory indicators were used to diagnose CMRFs, which included hypertension, dyslipidemia, impaired fasting glucose and abdominal obesity. Partial correlation analysis was used to evaluate the relationship among anthropometric indicators, area under the receiver operating characteristic curve (AUCs) were used to compare the predict ability of each anthropometric indicators, the cut-off value, sensitivity, specificity and Youden Index of each indicator were calculated. RESULTS In 3-6 years old children, ABSI-adolescent positively correlated with WC (r=0.727, P<0.001), BMI (r=0.218, P<0.001) and WHtR (r=0.752, P<0.001), and in 7-17 years old participants, the correlation coefficients increased to 0.842, 0.563 and 0.850 (P<0.001), respectively. BRI were strong correlated with BMI, WHtR and ABSI-adolescents in both age group (P<0.001). In 3-6 years group, the ROC analysis showed that BMI and ABSI were significantly better in identifying hypertension in both genders, WHtR and BRI were significantly better in identifying abdominal obesity in girls, but all of them were failed in identifying dyslipidemia and hyperglycemia. In 7-17 years group, WHtR and BRI were significantly better in identifying hypertension, dyslipidemia, abdominal obesity in both genders, BMI and ABSI performed better in identifying hyperglycemia in girls. CONCLUSIONS In Chinese children aged 3-6 years, there is no indicator performed best in all the CMRFs, in 7-17 years old teenagers, WHtR and BRI can be recommended to identify hypertension, dyslipidemia, abdominal obesity and clustered CMRFs in both genders. However, ABSI showed weak discriminative power.
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Affiliation(s)
- Rui Chen
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Lang Ji
- Central Laboratory, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yitong Chen
- Infectious Diseases Control and Prevention Division, Daxing Center for Disease Control and Prevention, Beijing, China
| | - Linghui Meng
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
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13
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Ezzatvar Y, Izquierdo M, Ramírez-Vélez R, Del Pozo Cruz B, García-Hermoso A. Accuracy of different cutoffs of the waist-to-height ratio as a screening tool for cardiometabolic risk in children and adolescents: A systematic review and meta-analysis of diagnostic test accuracy studies. Obes Rev 2022; 23:e13375. [PMID: 34751482 DOI: 10.1111/obr.13375] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/11/2022]
Abstract
The present systematic review with meta-analysis sought to estimate the accuracy of different waist-to-height ratio (WHtR) cutoff ranges as risk indicators for cardiometabolic health in different populations of children and adolescents. Systematic searches were undertaken to identify studies in apparently healthy participants aged 3-18 years that conducted receiver operating characteristic curve analysis and reported area under the receiver operating characteristic curves for WHtR with any cardiometabolic biomarker. Forty-one cross-sectional studies were included in the meta-analysis, including 138,561 young individuals (50% girls). Higher area under summary receiver operating characteristic (AUSROC) values were observed in cutoffs between 0.46 and 0.50 (AUSROC = 0.83, 95%CI: 0.80-0.86) and ≥0.51 (AUSROC = 0.87, 95%CI: 0.84-0.90) (p < 0.001 in comparison with cutoffs 0.41 to 0.45), with similar results in both sexes. The AUSROC value increased in the East and Southeast Asian regions using a WHtR cutoff of ≥0.46 (AUSROC = 0.90, 95%CI: 0.87 to 0.92). A cutoff of ≥0.54 was optimal for the Latin American region (AUSROC = 0.96, 95%CI: 0.94-0.97). Our meta-analysis identified optimal cutoff values of WHtR for use in children and adolescents from different regions. Despite the widely accepted WHtR cutoff of 0.50, the present study indicated that a single cutoff value of WHtR may be inappropriate.
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Affiliation(s)
- Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Pamplona, Spain
| | - Borja Del Pozo Cruz
- Centre for Active and Healthy Ageing, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Antonio García-Hermoso
- Navarrabiomed, Navarra Hospital Complex (CHN), Public University of Navarra (UPNA), Pamplona, Spain.,Sciences of Physical Activity, Sports and Health School, University of Santiago of Chile (USACH), Santiago, Chile
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Soliman H, Ahmed S, Ibrahim A. Waist-to-height ratio as a clinical predictor for cardiovascular risks and insulin resistance in children and adolescents with exogenous obesity. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [DOI: 10.1186/s43054-021-00085-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obesity is one of the most challenging clinical syndromes associated with deleterious health problems. Waist-to-height ratio (WHtR), a newer index for abdominal fat assessment, can be a superior tool in the evaluation of cardiometabolic risk. This study aimed to determine the relation between WHtR and lipid cardiovascular risk ratios and insulin resistance (IR) in children and adolescents with exogenous obesity.
Results
This analytical cross-sectional study included 80 children and adolescents with exogenous obesity, compared to 80 age- and sex-matched healthy non-overweight non-obese controls. Fasting lipid profile (total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL)), fasting insulin, and fasting blood glucose were done and lipoprotein risk ratios were calculated; TC/HDL, LDL/HDL, non-HDL/HDL, and TG/HDL). In addition, homeostatic model assessment for IR (HOMA IR), triglyceride glucose index (TyG), TyG-BMI, and TyG-WC were calculated. The study group included 55 (34.4%) males and 105 (65.6%) females with a mean age of 13.6 ± 2.22 years. Obese group had significantly higher TC, TG, LDL, non-HDL, LDL/HDL, TC/HDL, non-HDL/HDL, and TG/HDL, with significantly lower HDL. In addition, they had significantly higher FBG, HOMA IR, TyG, TyG-BMI, and TyG-WC indices compared to the control group. There were statistically significant correlations between WHtR and lipid profile, lipid risk ratios and indices of IR. WHtR was found to be an independent predictor of IR by linear regression analysis.
Conclusion
WHtR can be an excellent, easy, and reliable clinical predictor for cardiovascular risk and IR in children and adolescents with exogenous obesity.
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Siwarom S, Pirojsakul K, Aekplakorn W, Paksi W, Kessomboon P, Neelapaichit N, Chariyalertsak S, Assanangkornchai S, Taneepanichskul S. Waist-to-Height Ratio Is a Good Predictor of Metabolic Syndrome in Adolescents: A Report From the Thai National Health Examination Survey V, 2014. Asia Pac J Public Health 2021; 34:36-43. [PMID: 34590882 DOI: 10.1177/10105395211046474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to assess the performance of waist-to-height ratio (WHtR) in the prediction of metabolic syndrome and to determine the appropriate cutoff value in Thai adolescents. Demographic data, blood pressure, fasting blood glucose, and lipid profile were obtained from the Thai National Health Examination Survey V database. The performances of WHtR, waist circumference, body mass index (BMI), and BMI z-score were analyzed by the receiver operating characteristics. Among 2644 adolescents, metabolic syndrome was identified in 4.27%. The areas under the receiver operating characteristic curves of WHtR, waist circumference, BMI, and BMI z-score were comparable (0.924-0.960). Performance of WHtR was more constant across age groups compared with other parameters. Using the cutoff value of WHtR at 0.5 resulted in the sensitivity and specificity of 98.5%/83.4% and 88.9%/86.0% in males and females, respectively. In conclusion, the cutoff value of WHtR at 0.5 provided good sensitivity and specificity for identifying metabolic syndrome in both genders. However, the other clinical risk factors or more definite scores should be considered when further assessment.
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Affiliation(s)
| | | | | | - Witchuri Paksi
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Jiang Y, Dou Y, Chen H, Zhang Y, Chen X, Wang Y, Rodrigues M, Yan W. Performance of waist-to-height ratio as a screening tool for identifying cardiometabolic risk in children: a meta-analysis. Diabetol Metab Syndr 2021; 13:66. [PMID: 34127061 PMCID: PMC8201900 DOI: 10.1186/s13098-021-00688-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To provide the latest evidence of performance and robustness of waist-to-height ratio (WHtR) in discriminating clusters of cardiometabolic risk factors (CMRs) and promote WHtR in routine primary health care practice in children, a meta-analysis was used. METHODS Searches was performed in eight databases from inception to July 03, 2020. Inclusion criteria were: (1) observational study, (2) children and adolescents, (3) provided WHtR measurements, (4) had CMRs as outcomes, and (5) diagnostic studies. Exclusion criteria were: (1) non-original articles, (2) unable to extract 2 × 2 contingency tables, (3) not in English or Chinese language, (4) populations comprising clinical patients, or (5) duplicate articles. WHtR cutoff points, 2 × 2 contingency tables were extracted from published reports. Outcomes included: CMR clusters of at least three CMRs (CMR3), two (CMR2), one (CMR1), and CMR components. Bivariate mixed-effects models were performed to estimate the summarised area under the curves (AUSROC) with 95% CIs and related indexes. We conducted subgroup analyses by sex and East Asian ethnicity. RESULTS Fifty-three observational studies were included. The AUSROC reached 0.91 (95% CI: 0.88-0.93), 0.85 (95% CI: 0.81, 0.88) and 0.75 (95% CI: 0.71, 0.79) for CMR3, CMR2, and CMR1, respectively. The pooled sensitivity and specificity for CMR3 reached 0.84 and exceeded 0.75 for CMR2. For CMR1, the sensitivity achieved 0.55 with 0.84 for specificity. We had similar findings for our subgroup and sensitivity analyses. CONCLUSIONS WHtR shows good and robust performance in identifying CMRs clustering across racial populations, suggesting its promising utility in public health practice globally.
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Affiliation(s)
- Yuan Jiang
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Yalan Dou
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
| | - Hongyan Chen
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
| | - Yi Zhang
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaotian Chen
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Yin Wang
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Myanca Rodrigues
- Health Research Methodology Graduate Program, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Weili Yan
- Department of Clinical Epidemiology and Clinical Trial Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, 201102, People's Republic of China.
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China.
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Daily physical activity, cardiorespiratory fitness, nutritional status, endothelial function, and autonomic modulation in school-age adolescents: A principal component analysis. Obes Res Clin Pract 2021; 15:205-211. [PMID: 33903023 DOI: 10.1016/j.orcp.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE This study evaluated the association between cardiorespiratory fitness, abdominal obesity, blood pressure, endothelial function, and autonomic modulation in school-age adolescents exhibiting different levels of habitual physical activity and nutritional status, through a multivariate statistical approach. METHODS 101 adolescents aged 15-18 years (54 females) underwent assessments of daily physical activity, body mass index, cardiorespiratory fitness, reactive hyperemia, and heart rate variability. Based on BMI adjusted for age and sex (z-BMI), 21 adolescents were classified as 'overweight' (9 girls), and 9 as 'obese' (4 girls). The common variation between those variables was assessed through Principal Component Analysis (PCA). RESULTS Main axis of common variation of outcomes analyzed defined four principal components (PCs) accounting for 69.7% of overall variance, related to 'abdominal obesity and blood pressure' (PC1; eigenvalue=2.76), 'cardiorespiratory fitness, endothelial function, and autonomic modulation' (PC2, eigenvalue=1.98), 'cardiorespiratory fitness' (PC3, eigenvalue=1.21), and 'sedentary behavior' (PC4, eigenvalue=1.02). Girls reported longer screen time and sedentary behavior than boys. Notwithstanding, in both sexes poorer cardiorespiratory fitness corresponded to lower reactive hyperemia and vagal modulation, irrespective of the nutritional status. Overall, adolescents classified as 'obese' and 'sedentary' exhibited poorer CRF concomitantly to autonomic and endothelial dysfunctions. CONCLUSION In school-age adolescents, endothelial and autonomic dysfunctions related to poor cardiorespiratory fitness, irrespective of the nutritional status and physical activity level. However, endothelial and autonomic dysfunctions were more prevalent among adolescents combining poor cardiorespiratory fitness, reduced levels of daily physical activity, and overweight/obesity.
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Wang H, Zhao M, Magnussen CG, Xi B. Utility of Three Adiposity Indices for Identifying Left Ventricular Hypertrophy and Geometric Remodeling in Chinese Children. Front Endocrinol (Lausanne) 2021; 12:762250. [PMID: 34867803 PMCID: PMC8636598 DOI: 10.3389/fendo.2021.762250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/01/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous studies have shown that waist-to-height ratio (WHtR) performed similarly well when compared to body mass index (BMI) and waist circumference (WC) for identifying cardiovascular risk factors. However, to our knowledge, the performance of these three adiposity indices for identifying left ventricular hypertrophy (LVH) and left ventricular geometric (LVG) remodeling in youth has not been assessed. We aimed to determine the utility of BMI, WC and WHtR for identifying LVH and LVG in Chinese children. METHODS This study included 1,492 Chinese children aged 6-11 years. Adiposity indices assessed were BMI, WC and WHtR. LVH and high relative wall thickness (RWT) were defined using sex- and age-specific 90th percentile values of left ventricular mass index and RWT, respectively, based on the current population. LVG remodeling included concentric remodeling (CR), eccentric hypertrophy (EH) and concentric hypertrophy (CH), which was defined based on the combination of LVH and high RWT. RESULTS The magnitude of association of central obesity defined by WHtR with LVH [odds ratio (OR) =10.09, 95% confidence interval (CI) =6.66-15.29] was similar with general obesity defined by BMI (OR=10.49, 95% CI=6.97-15.80), and both were higher than central obesity defined by WC (OR=6.87, 95% CI=4.57-10.33). Compared with BMI, WHtR had better or similar predictive utility for identifying LVH, EH, and CH [the area under the curve (AUC): 0.84 vs. 0.79; 0.84 vs. 0.77; 0.87 vs. 0.88, respectively]; WC had worse or similar discriminatory utility with AUCs of 0.73, 0.70, 0.83, respectively. CONCLUSION WHtR performed similarly or better than BMI or WC for identifying LVH and LVG remodeling among Chinese children. WHtR provides a simple and convenient measure of central obesity that might improve the discrimination of children with cardiac structural damage.
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Affiliation(s)
- Huan Wang
- Department of Epidemiology/Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, School of Public Health/Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Zhao
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Bo Xi
- Department of Epidemiology/Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, School of Public Health/Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Bo Xi,
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